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By Jennifer Kasper
It was during my year as Pediatric Chief Resident at Boston City Hospital that I realized I wanted to work in a Central American country to learn Spanish and something about the people so that I could provide more culturally sensitive medical care to the many Latin Americans in Boston. Little did I know at that time how fortunate I was to be accepted as an MDS/DGH volunteer, accompanying the campesinos in a rural part of El Salvador. (MDS was DGH's partner organization in El Salvador between 1995 and 2004.) Everything I have experienced and learned go far beyond proficiency in speaking Spanish. When I landed in San Salvador in January of 1996, I experienced what it means to be a stranger in a strange land. As I negotiated my way through the visa process, baggage claim, and customs replete with necessary medical and educational supplies, I developed an appreciation for the multitudes of immigrants that attempt to make their way through our U.S. system.
My initiation to life with MDS took the form of a call over the short-wave radio that same day. One of the health promoters working in the clinic had seen a woman who had an abortion two months earlier and arrived at the clinic with a "coconut-sized" mass in her abdomen. With my second-grade Spanish I struggled to communicate over the static. I was able to elicit enough information to conclude that the woman was not in shock, but I was left with a differential diagnosis that included anything from retained products of conception to parasites. The health promoter had decided to refer her to the hospital, but the woman did not want to go because she had no money and she was not familiar with the town where the hospital was. To provide some perspective, the woman lived about three hours from the hospital (a combination of walking and taking a bus), yet had never been there before. So the Health Promoter planned to visit her again in the morning and try to convince her that she needed more intensive medical attention. All I could do was listen and offer advice and support.
After that introduction, I participated in the global planning for the coming year with the technical support team. I was warmly welcomed by Maruca, a physician and coordinator of the "campo" and the president of MDS; Lanny, a physician and legal representative of MDM and President of DGH; Irma and Rosibel, two physicians; René, the psychologist; Fatima, the physical therapist; and Arthur, an American medical student volunteer. They immediately included me in the discussions, although at that point I was simply trying to follow the Spanish. We have since added a few people to our multidisciplinary team, namely a nutritionist, an agricultural specialist, an educational specialist, and an amazing office staff and group of logisticians that help us get from point a to b, c, d, and e! Morazán, the department where we work, is in the rural eastern part of the country, a nerve-wracking, cow-dodging, bone-jarring five-hour ride in a four-by-four from the capital, San Salvador. We focus our energies on three municipalities-Sociedad, Corinto, and Cacaopera-with a population of about 40,000. MDS/ MDM provides preventive medical accompaniment for about 15,000 of these persons.
The Rio Torola runs through this area. It served as the dividing line between the FMLN and government forces during the twelve-year armed conflict (1980-1992). As a consequence of the bombing and massacres that occurred (read El Mozote, by Mark Danner), the people, their homes, and the land were severely devastated. We are working to help repair the damage of the armed conflict and help the campesinos live a dignified life. The goals of the organization, simply stated, are to improve access to health care; provide education and participation regarding health and human rights; and promote projects that directly benefit the communities through participatory investigation. During my two-year stay I witnessed first-hand how these goals are put into practice.
The lifeblood of the organization are the General Health Promoters, the Mental Health Promoters (the teachers in the Centers for Integral ChildDevelopment or CIDIs), and the Midwives. To contribute to the right to health care, our organization built-with the help of the community - a clinic-school (the nearest hospital is a minimum two-hour bus ride and the only children's hospital is a daylong bus trip to the capital, San Salvador). This clinic is run by the General Health Promoters with the help of physicians and others in our group. It has three examination rooms where we can perform gynecological exams and small surgical procedures. There is also a self-sustaining pharmacy with basics like antibiotics, analgesics, and antacids, as well as more "exotic" things such as natural medicines, iodized salt, and soybeans. We have just completed an addition to the clinic that will house a physical therapy room, a dental clinic, and a clinical laboratory. We care for all ages, 0-100, and treat a gamut of illnesses, everything from malnutrition and parasites to basal cell carcinoma. I really enjoy working side-by-side with the Health Promoters and other physicians and members of the team, providing one-on-one teaching. It has been great fun for me to be able to teach them the newborn and pediatric physical exams, knowing that they will use these skills to provide the best care they can to the people in their communities.
The educational aspect of our organization consists of each group of Health Promoters (i.e. the Midwives, Mental Health, General Health, and most recently the Community-Based Rehabilitation) receiving a week of instruction every six weeks. The curriculum is quite integral, including subjects as varied as geography, history, literature, nutrition, gardening, and human rights. I'll never forget the look on the Midwives' faces at the prospect of learning to read and write (the majority of all the Health Promoters have no prior formal education). It is such a thrill to be part of their training because they so much want to learn.
The General Health Promoters work in the clinic-school one week a month, receive one week of instruction every six weeks, and design and implement public health projects with the help of their communities. The philosophy behind this is that we are not in the business of giving free handouts or of deciding for the community what we think is best for them. We trust each community to prioritize its necessities. Each person in the community must then volunteer time to make the projects a reality. This is what we mean by participatory investigation: each community investigating its needs and then participating in meeting/correcting those needs.
Therefore, our projects are quite varied and include everything from building latrines and chlorinating the water, to growing soybeans and learning how to use them to improve nutrition, planting community gardens, and learning about natural medicine (see sidebar below for a description of some of our larger projects).
Hopefully, in these varied ways, we can continue to put our philosophy to work, "Building health and human rights where the peace is new."
Long-Term Community Projects Underway |
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